Test 2 Flashcards
(80 cards)
describe TOC
movement of pt between a healthcare system and providers. ensure coordination among healthcare professionals
pre-discharge
med rec, pt edu, discharge planning, scheduling follow-up
post-discharge
follow-up phone call,
communication with ambulatory provider, home visits
bridging
transition coach that acts as a patient advocate, patient-centered discharge instructions to increase patient buy-in, clinician continuity with inpatient/outpatient providers, transition coach may attend follow up visits
groups at high risk for adverse drug events within care transitions
older adults, limited health literacy, terminal patients, children with special needs, patients taking more than 5 meds daily, cognitive impairment, complex medical/behavioral health conditions, lower income, new admits to LTCF, homeless
pharmacists role in TOC
med reconciliation: comparing med history and what physician has ordered at admin, transfer, discharged to avoid omissions, errors, duplicates, and ADE
pharmacists role at admin
identify outpatient meds (history), assess adherence and health literacy, reconcile with current medical state
pharmacists role at inpatient transfer
ensure adequate hand-off to ensure continuity between
pharmacists role at discharge review
med list correct and optimized based on inpatient changes, counsel, assess access to medications, promote adherence, follow-up
community pharmacist activities after discharge
perform home visits, review automated refill programs, help with interpretation of discharge paperwork, assist with third-party formulary review
create a plan for improving medication management during TOC
- start patient education earlier (days before discharge), use established educational techniques, follow-up with patient after discharge
Comparative Effectiveness Research (CER)
CER is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or improve the delivery of care. Purpose is to inform decisions that will improve healthcare at both the individual and population levels
1972 CER
establishment of the Office of Technology Assessment (OTA), an advisory committee to Congress tasked with evaluating the effectiveness of healthcare services
1975 CER
establishment of the National Center for Healthcare Technology (NCHT) with the purpose of endorsing research on health technologies
1989 CER
establishment of what came to be known as the Agency for Healthcare Research and Quality (AHRQ) to facilitate the development of timely evidence and update clinical practice guidelines
2003 CER
Medicare Prescription Drug, Improvement, and Modernization Act (MMA) mandates that the AHRQ conduct research into effective healthcare programs
2009 CER
American Recovery and Reinvestment Act provided funding for CER, mandated the establishment of the Federal Coordinating Council for CER, and required the IOM to report back to Congress within a few months of passage
2010 CER
establishment of the Patient-Centered Outcomes Research Institute (PCORI), a non-profit, independent organization to fund CER initiatives
American Recovery and Reinvestment Act legislated efforts for CER
increased funding for CER by 1.1 billion
established federal coordinating council for CER
purpose: help agencies of the federal government in coordinating comparative effectiveness and related health services research
agencies: AHRQ, NIH, CDC, CMS, FDA, VA
coordination functions: research infrastructure, methods and workforce development
efficacy- CER
health care intervention is beneficial when administered under optimal circumstances. efficacy is whether or not something works under carefully controlled conditions.
Efficacy studies have strict inclusion/exclusion criteria, involve highly standardized treatments, have explicit procedures for ensuring compliances, and focus on direct outcomes.
RCT
The gold standard of generation of efficacy data is through randomized clinical trials (RCTs).
Effectiveness - CER
health care intervention does more good than harm when provided to a wide assortment of real-world patients with different baseline health risks by physicians or other care providers practicing in diverse clinical settings. effectiveness is how well something works under actual conditions.
Effectiveness studies have looser inclusion/exclusion criteria, involve treatments carried out by typical clinical personnel, have little or no provision for ensuring compliance, and focus on less direct outcomes (e.g., quality of life).
Generation of effectiveness data is done through
effectiveness trials, pragmatic trials, and observational studies.
tenets distinguish CER from clinical research in general
- informs a specific clinical decision from the individual patient perspective or health policy decision from the population perspective
- compares two alternative interventions that provide benefit
- describes results at the population and subgroup levels
- measures outcomes - both benefits and harms - that are important to patients and decision makers
- employs methods and data sources appropriate for the decision of interest
- conducted in settings that are similar to those in which the intervention will be used in practice
